Antiplatelet Therapy with Cangrelor in Patients Undergoing Surgery after Coronary Stent Implantation: A Real-World Bridging Protocol Experience

Roberta Rossini; Giulia Masiero; Claudia Fruttero; Enrico Passamonti; Elba Calvaruso; Moreno Cecconi; Cesare Carlucci; Marco Mojoli; Parodi Guido; Giuseppe Talanas; Simona Pierini; Paolo Canova; Nicoletta De Cesare; Stefania Luceri; Nicoletta Barzaghi; Giulio Melloni; Giorgio Baralis; Alessandro Locatelli; Giuseppe Musumeci; Dominick J. Angiolillo

doi:10.1055/s-0040-1721504

TH Open, Inhaltsverzeichnis

CC BY 4.0 · TH Open 2020; 04(04): e437-e445
DOI: 10.1055/s-0040-1721504

Original Article

Antiplatelet Therapy with Cangrelor in Patients Undergoing Surgery after Coronary Stent Implantation: A Real-World Bridging Protocol Experience

Roberta Rossini^*

¹Ospedale Santa Croce e Carle, Cuneo, Italy

,

Giulia Masiero ^*

¹Ospedale Santa Croce e Carle, Cuneo, Italy

,

Claudia Fruttero

¹Ospedale Santa Croce e Carle, Cuneo, Italy

,

Enrico Passamonti

²Ospedale di Cremona, Struttura Complessa di Cardiologia, Cremona, Italy

,

Elba Calvaruso

²Ospedale di Cremona, Struttura Complessa di Cardiologia, Cremona, Italy

,

Moreno Cecconi

³Ospedale di Civitanova Marche, Civitanova Marche, Italy

,

Cesare Carlucci

³Ospedale di Civitanova Marche, Civitanova Marche, Italy

,

Marco Mojoli

⁴Ospedale Santa Maria degli Angeli, Pordenone, Pordenone, Italy

,

Parodi Guido

⁵Azienda Ospedaliera Universitaria di Sassari, Struttura Complessa di Cardiologia Clinica ed Interventistica, Sassari, Italy

,

Giuseppe Talanas

⁵Azienda Ospedaliera Universitaria di Sassari, Struttura Complessa di Cardiologia Clinica ed Interventistica, Sassari, Italy

,

Simona Pierini

⁶P.O. BASSINI—ASST Nord Milano, U.O.C. Cardiologia, Milano, Italy

,

Paolo Canova

⁷ASST Papa Giovanni XXIII, Unità di Cardiologia 2, Bergamo, Italy

,

Nicoletta De Cesare

⁸Policlinico san Marco, IOB, Zingonia-Osio Sotto, Bergamo, Italy

,

Stefania Luceri

⁹Cardiology Division, Ospedale Mauriziano, Torino, Italy

,

Nicoletta Barzaghi

¹Ospedale Santa Croce e Carle, Cuneo, Italy

,

Giulio Melloni

¹Ospedale Santa Croce e Carle, Cuneo, Italy

,

Giorgio Baralis

¹Ospedale Santa Croce e Carle, Cuneo, Italy

,

Alessandro Locatelli

¹Ospedale Santa Croce e Carle, Cuneo, Italy

,

Giuseppe Musumeci

¹Ospedale Santa Croce e Carle, Cuneo, Italy

,

Dominick J. Angiolillo

¹⁰University of Florida College of Medicine, Jacksonville, Florida, United States

› Institutsangaben

Abstract

Objective The aim of the study is to describe the real-world use of the P2Y₁₂ inhibitor cangrelor as a bridging strategy in patients at high thrombotic risk after percutaneous coronary intervention (PCI) and referred to surgery requiring perioperative withdrawal of dual antiplatelet therapy (DAPT).

Materials and Methods We collected data from nine Italian centers on patients with previous PCI who were still on DAPT and undergoing nondeferrable surgery requiring DAPT discontinuation. A perioperative standardized bridging protocol with cangrelor was used.

Results Between December 2017 and April 2019, 24 patients (mean age 72 years; male 79%) were enrolled. All patients were at high thrombotic risk after PCI and required nondeferrable intermediate to high bleeding risk surgery requiring DAPT discontinuation (4.6 ± 1.7 days). Cangrelor infusion was started at a bridging dose (0.75 µg/kg/min) 3 days before planned surgery and was discontinued 6.6 ± 1.5 hours prior to surgical incision. In 55% of patients, cangrelor was resumed at 9 ± 6 hours following surgery for a mean of 39 ± 38 hours. One cardiac death was reported after 3 hours of cangrelor discontinuation prior to surgery. No ischemic outcomes occurred after surgery and up to 30-days follow-up. The mean hemoglobin drop was <2 g/dL; nine patients received blood transfusions consistent with the type of surgery, but no life-threatening or fatal bleeding occurred.

Conclusion Perioperative bridging therapy with cangrelor is a feasible approach for stented patients at high thrombotic risk and referred to surgery requiring DAPT discontinuation. Larger studies are warranted to support the safety of this strategy.

Keywords

antiplatelet therapy - stent - surgery - bridging - cangrelor

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Referenzen

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